Key result
Targeting a functional isthmus during catheter ablation of atrial flutter required fewer radiofrequency pulses compared to conventional ablation.
Why the study?
Does targeting a functional isthmus formed by preexisting double potential barrier at the CTI improve the efficiency of radiofrequency catheter ablation in patients with isthmus-dependent atrial flutter?
Cohort (n=43)
Does targeting a functional isthmus formed by preexisting double potential barrier at the CTI improve the efficiency of radiofrequency catheter ablation in patients with isthmus-dependent atrial flutter?
Targeting a functional isthmus formed by a preexisting double-potential barrier at the CTI significantly reduces the number of RF pulses and ablation line length required for successful ablation of isthmus-dependent atrial flutter.
Answers are grounded in this paper and cite their sources.
May reduce ablation burden in isthmus-dependent flutter; hypothesis-generating for randomized outcome trials.
INTRODUCTION: The aim of the study was to identify an alternative target for more effective radiofrequency catheter ablation (RFCA) of isthmus-dependent atrial flutter (AFL). METHODS AND RESULTS: We hypothesized that a functional isthmus formed by preexisting double potential barrier at the cavotricuspid isthmus (CTI) could serve as a new target site for facilitating RFCA of AFL. Forty-three consecutive patients with recurrent isthmus-dependent AFL were studied using three-dimensional navigated magnetic mapping and ablation technique. Twenty patients (47%, group A) were shown to have a narrower functional channel at the CTI (functional isthmus). The remaining 23 patients did not have this feature (53%, group B). In group A, double potentials were clustered near the border of the inferior vena cava (IVC) of the CTI and served as a functional channel along the tricuspid annulus (TA). The interspike interval of double potentials was 87 +/- 26 ms near the IVC border and 45 +/- 17 ms (P < 0.0001) near the TA border of CTI. RFCA targeting at the functional isthmus in group A resulted in interruption of bidirectional transisthmus conduction with fewer radiofrequency pulses (6.7 +/- 4.7 in group A vs 21.1 +/- 17.1 pulses in group B, P < 0.001), shorter ablation line (11.6 +/- 4.0 mm vs 37.8 +/- 7.2 mm, P < 0.0001) with no arrhythmia recurrence. These functional isthmuses were found to be located at the lateral third of CTI in 12 patients, middle third in 7, and medial third in 1. This finding is different from that obtained by the conventional method in group B (lateral in 5, middle in 16, medial in 2, P < 0.038). CONCLUSION: In our study, a functional, rather than anatomic, isthmus formed by preexisting double-potential barrier at the CTI was identified in 47% of patients with isthmus-dependent AFL. It is a useful guide to facilitate RFCA of isthmus-dependent AFL.
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Lai et al. (2004) conducted a cohort in recurrent isthmus-dependent atrial flutter (n=43). Radiofrequency catheter ablation targeting the functional isthmus vs. Conventional radiofrequency catheter ablation was evaluated on Number of radiofrequency pulses (p=<0.001). Targeting a functional isthmus during catheter ablation of atrial flutter required fewer radiofrequency pulses compared to conventional ablation.
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